In Cord Blood

Under bright white lights, several pairs of hands reach into a gaping red gash in the very pregnant belly of Rosa Simmons. With a squelch, her seven-pound daughter Emily, gray and wriggling, appears.

It is June 6 at Northwest Medical Center in Margate. Rosa Simmons' cesarean section has been swift and uneventful — except for the presence of a camera crew. But the crew isn't here to film Emily's birth.

Now that the delivery is over, the real show can begin.

"We are going to demonstrate how we obtain umbilical cord blood," says Dr. Bruce Zafran, Rosa's Coral Springs gynecologist. He is speaking to a live audience watching via webcast, linked through the St. Petersburg offices of a company called Cryo-Cell.

"This is a very simple procedure," Zafran narrates as the camera zooms in on the greenish umbilical cord, which is resting, surrounded by crimson puddles of blood, on Rosa's abdomen.

As the camera rolls, a nurse presses the sharp tip of a long needle against the ridged skin of the umbilical cord. It pierces the surface, and dark-red blood wells up through clear tubing to drip into a clear plastic bag.

"We will try to drain approximately 100 to 150 cc's of cord blood to save the umbilical cord blood stem cells," Zafran says as the bag slowly fills with the dark maroon liquid. "We should have a very good specimen collection to send to Cryo-Cell."

Cryo-Cell, which preserves and stores umbilical cord blood, has paid Zafran to arrange this demonstration. Most umbilical cords are discarded as medical waste after birth. But Cryo-Cell encourages parents to "bank" the stem cells that are found in cord blood for use in future years.

There's good reason to save cord blood: It can be used in lifesaving transfusions to cure a variety of diseases such as lymphoma and leukemia. Painless to collect, cord blood has become a convenient alternative to bone marrow, which also contains blood-producing stem cells.

Cryo-Cell urges parents to store cord blood so that if a child later develops an illness, the child's own blood is a match, of course, and can be used if a transplant or transfusion is needed. The blood may also be a match for siblings or other family members.

But for years, experts have warned that the chances of a family ever benefiting from the stored cord blood of its own children are slim to none. When a child uses its own cord blood, it is referred to as an "autologous" transfusion. But autologous transfusions can't treat most diseases, and the chances of a match for a sibling is 1-in-4.

Both the American Medical Association and the American College of Obstetricians and Gynecologists discourage new parents from banking cord blood privately and encourage them instead to donate to the growing national network of public banks, where cord blood may be used to save someone else's life.

But that disapproval hasn't stemmed the popularity of private banking. In fact, business is booming — Cryo-Cell, one of the top three private cord blood banks in the country, has more than 100,000 units of cord blood stored in its Oldsmar facility. For families convinced, despite evidence to the contrary, that their child may benefit from its own stored blood, the price may seem reasonable: $1,500, plus a yearly $100 storage fee for as long as a family is willing to pay.

For ethical reasons, however, it's a doctor's job to explain to patients that private cord blood banking is a slim hope at best. But working against those ethics is another persuasive force: Obstetrician-gynecologists are under heavy pressure from private cord blood banks themselves, which employ incentives and advertising to convince doctor and patient alike that cord blood banking is, despite the odds, a smart choice.

Bruce Zafran, Rosa Simmons' ob-gyn, is on Cryo-Cell's payroll as a consultant and acts as the company's spokesman. With his participation in the webcast of the birth of Emily Simmons, he has also become an advertiser. Although he insists that he remains objective, Zafran's relationship with Cryo-Cell illustrates how the private cord blood industry is paying doctors to keep a problematic and largely useless service alive — and profitable.

Two months after Emily's birth, Matthew and Rosa Simmons' cramped condo in Margate is womblike in cool semi-darkness, lit only by the television and the warm flickering of several candles placed on the coffee table in anticipation of a reporter's arrival.

The young Latino couple has been through this routine before. Following the webcast of Emily's birth, they were abruptly thrust into the spotlight when several newspapers, including the South Florida Sun-Sentinel, interviewed them about the promise of Cryo-Cell.

Both parents work long hours at the nearby Northwest Medical Center, Matthew as a cook and Rosa as a sterilization specialist. Both are employed, in effect, by Zafran, who is chairman of the board at Northwest Medical Center. Rosa chose Zafran as her ob-gyn because she saw him every day on the job. She now considers him a personal friend and laughs about how he insists on speaking to in her native Spanish.